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Multiple Sclerosis: How to Prevent Unnecessary Complications

If you have multiple sclerosis (MS), by now, one of your friends or family members has probably mentioned to you that he or she knew someone “who died of MS.” Try not to panic. Even though death can occasionally result from a virulent, rapidly progressive form of MS or from very severe complications, most people who have MS die from cancer, heart disease, and stroke like everyone else.

The primary MS health risks are caused by preventable complications, including:

  • Urinary tract infections: These types of infections are relatively common in MS. The important message here is that untreated urinary tract infections not only make other MS symptoms feel worse, but they can also lead to serious kidney problems and urosepsis (which occurs when bacteria from the infection gets into the bloodstream).

    For these reasons, prompt diagnosis and treatment of urinary tract infections (by your neurologist, primary care physician, or urologist) is important.

  • Spasticity (stiffness): This symptom is common in MS. When left untreated, spasticity can lead to contractures, or freezing of the joints, which is a painful and debilitating problem. The best way to avoid contractures is to use a regimen of stretching (and medication, if needed) to keep your joints flexible. Your neurologist and physical therapist can recommend the appropriate treatment strategies for you.

  • Dysphagia: Some people with MS develop dysphagia (problems with swallowing). Coughing or choking while eating may be a sign that you’re developing a swallowing problem. Promptly reporting these kinds of changes to your physician is important because untreated swallowing problems can lead to aspiration pneumonia, which is caused by food particles that travel into the lungs rather than through the esophagus and into the stomach where they belong.

    This condition, like all types of pneumonia, can be serious and dangerous. A speech/language pathologist can assess the type and severity of your swallowing problem, and he or she can recommend the appropriate interventions. And if the swallowing difficulties also interfere with your ability to get adequate nutrition, a nutritionist can make personalized dietary recommendations for you.

  • Skin problems: If you spend extended periods of time in a scooter, wheelchair, or bed, you need to take particularly good care of your skin because you’re at risk for pressure sores. These sores develop when parts of your body are in constant contact with your bed or chair.

  • Over time, this pressure restricts blood flow, resulting in damage to the skin in those areas, and eventually loss of the skin tissue and severe infection. The buttocks and heels are particularly vulnerable to pressure sores, as are any bony areas, such as hips, elbows, and ankles. So, if your mobility is severely restricted, check your skin carefully every day for signs of redness or irritation. Immediately report any changes to your doctor.

  • The best way to deal with pressure sores is to prevent them from happening in the first place — by making sure you change position often and lift your butt (and other parts of your body) off the bed or chair every hour or so. Keeping your skin dry but moisturized can also help, as can a healthy diet with adequate fluids.

  • Osteoporosis: The risk of osteoporosis (the thinning of your bones) is increased for women and men with limited mobility who get insufficient amounts of weight-bearing exercise (like you get from standing and walking).

    Frequent use of corticosteroids is also known to increase the risk of osteoporosis. So, if you spend significant amounts of time sitting down (or if you take corticosteroids often), get a baseline bone density evaluation, which is generally done by a radiologist, and you should have periodic screenings thereafter. Also make sure that you’re taking in the recommended amount of calcium and vitamin D.

  • Respiratory problems: Like other muscles that can become weakened by inadequate nerve stimulation or inactivity, the muscles that support your breathing can also be affected by MS.

    Let your physician know if taking in full breaths is more difficult or more tiring or if you run out of breath during normal conversation. A respiratory therapist — who is most often a PT or nurse — can give you exercises to strengthen your breathing apparatus and help you breathe more comfortably.

  • Depression: Depression, which is very common in MS, is the primary risk factor for suicide. Because people with MS often don’t recognize their depression, it tends to go untreated.

    One result of this inadequate treatment of depression is that the suicide rate in MS is significantly higher than in the general population. The good news is that depression is one of the most treatable MS symptoms. So don’t hesitate to report mood changes to your doctor.

Even though the risk of these complications is real, the upside is that doctors now have the know-how to prevent many unnecessary complications of MS and more treatment strategies to manage them if they occur. Close communication with your healthcare team is the key to minimizing the potential complications of MS.

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